Highlights
- •Persistent or new congestion within the first 24 hours of cardiogenic shock is associated with worse outcomes.
- •BiV or persistent congestion and higher SCAI stages are associated with worsening hemodynamics.
- •Incorporating hemodynamic and congestion assessment plus SCAI stages in AMI-CS could potentially impact clinical outcomes by optimizing guideline-directed therapies.
ABSTRACT
Background
Cardiogenic shock (CS) commonly complicates the management of acute myocardial infarction
(AMI), and it results in high mortality rates. Pulmonary artery catheter (PAC) monitoring
can be valuable for personalizing critical-care interventions. We hypothesized that
patients with AMI-CS experiencing persistent congestion measures during the first
24 hours of the PAC installment would exhibit worse in-hospital survival rates.
Methods and Results
We studied 295 patients with AMI-CS between January 2006 and December 2021. The first
24-hour PAC-derived hemodynamic measures were divided by the congestion profiling
and the proposed 2022 Cardiovascular Angiography and Interventions (SCAI) classification.
Biventricular congestion was the most common profile and was associated with the highest
patient mortality rates at all time points (mean 56.6%). A persistent congestive profile
was associated with increased mortality rates (hazard ratio [HR] = 1.85; P = 0.002) compared with patients who achieved decongestive profiles. Patients with
SCAI stages D/E had higher levels of right atrial pressure (RAP): 14–15 mmHg) and
pulmonary capillary wedge pressure (PCWP): 18–20 mmHg) compared with stage C (RAP,
10–11 mmHg, mean difference 3–5 mmHg; P < 0.001; PCWP 14–17 mmHg; mean difference 1.56–4 mmHg; P = 0.011). In SCAI stages D/E, the pulmonary artery pulsatility index (0.8–1.19) was
lower than in those with grade C (1.29–1.63; mean difference 0.21–0.73; P < 0.001).
Conclusions
Continuous congestion profiling using the SCAI classification matched the grade of
hemodynamic severity and the increased risk of in-hospital death. Early decongestion
appears to be an important prognostic and therapeutic goal in patients with AMI-CS
and warrants further study.
Graphical Abstract
Graphical AbstractDynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction
Complicated by Cardiogenic Shock Outcomes. In AMI-CS the first 24 hours of hemodynamic
monitoring after PAC placement demonstrated that patients with persistent or new congestion
(red line) had a higher overall mortality. SCAI stages D and E had worse hemodynamic
profiles and higher mortality rates in AMI-CS.
Key Words
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References
- Twenty-year trends in the incidence and outcome of cardiogenic shock in AMIS plus registry.Circ Cardiovasc Interv. 2019; 12https://doi.org/10.1161/CIRCINTERVENTIONS.118.007293
- Temporal trends in the epidemiology, management, and outcome of patients with cardiogenic shock complicating acute coronary syndromes.Eur J Heart Fail. 2015; 17: 1124-1132https://doi.org/10.1002/EJHF.339
- Cardiogenic shock among patients with and without acute myocardial infarction in a Latin American country: a single-institution study.Glob Heart. 2021; 16https://doi.org/10.5334/GH.988
- SCAI SHOCK stage classification expert consensus update: a review and incorporation of validation studies.J Am Coll Cardiol. 2022; https://doi.org/10.1016/j.jacc.2022.01.018
- Invasive hemodynamic assessment and classification of in-hospital mortality risk among patients with cardiogenic shock.Circ Heart Fail. 2020; 13e007099https://doi.org/10.1161/CIRCHEARTFAILURE.120.007099
- Cardiogenic shock classification to predict mortality in the cardiac intensive care unit.J Am Coll Cardiol. 2019; 74: 2117-2128https://doi.org/10.1016/J.JACC.2019.07.077
- Complete hemodynamic profiling with pulmonary artery catheters in cardiogenic shock is associated with lower in-hospital mortality.JACC Hear Fail. 2020; 8: 903-913
- A pragmatic approach to weaning temporary mechanical circulatory support: a state-of-the-art review.JACC Heart Fail. 2021; 9: 664-673https://doi.org/10.1016/J.JCHF.2021.05.011/SUPPL_FILE/MMC1.DOCX
- Right ventricular dysfunction is common and identifies patients at risk of dying in cardiogenic shock.J Card Fail. 2021; 27: 1061-1072https://doi.org/10.1016/j.cardfail.2021.07.013
- Hemodynamic predictors of heart failure morbidity and mortality: fluid or flow?.J Card Fail. 2016; 22: 182-189https://doi.org/10.1016/J.CARDFAIL.2015.11.012
- Right ventricular dysfunction in acute myocardial infarction complicated by cardiogenic shock: a hemodynamic analysis of the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial and registry.J Card Fail. 2018; 24: 148-156https://doi.org/10.1016/J.CARDFAIL.2017.10.009
Article info
Publication history
Published online: November 04, 2022
Accepted:
October 12,
2022
Received in revised form:
October 10,
2022
Received:
June 30,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
